Toujeo (Insulin Glargine)

By Rebecca Dugas

Toujeo, which came to market in early 2015, is a form of man-made insulin known as insulin glargine. There are two other brands of insulin glargine on the market: Lantus (also made by Sanofi Aventis) and Basaglar (produced by Eli Lilly).

Although Toujeo and Lantus are both insulin glargine and produced by the same company, Toujeo’s formulation makes it a more concentrated form of this medication. One milliliter of Toujeo contains three times as much insulin as Lantus. The higher concentration means that patients can inject a lower volume of insulin.

How Does Toujeo Work?

This basal insulin works by forming crystals inside the body, which gradually dissolve and release small amounts of insulin into the bloodstream over the course of 24 hours or longer (up to 36 hours). This mimics the action of the pancreas and this slow and steady release has been proven to lower A1c levels significantly.

Some people have been able to reduce or eliminate other oral diabetes medications while taking Toujeo and were still able to achieve their target A1c goals.

Unlike most other insulins, Toujeo has no pronounced peak and it doesn’t “wear off” between doses. It does take several hours to take effect, however. Its onset is approximately six hours after injection, as opposed to the 1-2 hours for Lantus. This extended onset helps to lower the incidence of hypoglycemia (low blood sugar).

Toujeo should be used once a day, at the same time every day.

It’s also important to note that it can take “five to eight days of daily dosing to reach a functional concentration” in the body, according to Healthline.

Who Should Take Toujeo?

Toujeo is used to treat type 1 diabetes in adults and in children no younger than six years old. It is also used to treat adults with type 2 diabetes.

Toujeo should not be used to treat diabetes type 2 in children of any age.

People who are allergic to insulin glargine or any other ingredients in Toujeo should not take it.

How is Toujeo Administered?

Toujeo is available only in the form of a pre-filled injection pen. Once opened, a Toujeo Solostar pen can remain unrefrigerated for up to 42 days (compared to 28 days for the Lantus Solostar pen). The new pens will carry 50% more medication than the Lantus Solostar pens (450 units, compared to 300 units of Lantus).

It should never be used in an insulin pump.

Toujeo should never be administered intravenously, as it requires subcutaneous injection to work the way it was designed to.

What Are Toujeo’s Side Effects?

Toujeo’s most common side effect, as with any insulin, is hypoglycemia (or low blood sugar). Be sure you and your family know the signs of hypoglycemia and how to treat it immediately, to avoid the seizures, unconscious, and even death that can result from not treating a low blood sugar.

If you accidentally take too much Toujeo (which has happened, since the concentration and dosages have changed), seek emergency medical attention. Since Toujeo continues to work for up to 36 hours after injection, the risk of hypoglycemia is prolonged.

Other side effects that may be experienced with Toujeo include the following:

Fever, sore throat, stuffy or runny nose (Check with your doctor if you experience any of these less common side effects.)

Injection site reactions (Always be sure to rotate your injection sites to reduce the risk of tissue damage.)

Immunity to insulin (Although the body can develop an immunity to any type of insulin, Toujeo may have a higher potential for developing immunity to insulin glargine than Lantus.)

Heart failure (Heart failure is a more common side effect of Toujeo in patients who also take TZDs.)

Does Toujeo Work Better Than Lantus?

Strangely, even though Toujeo is a concentrated form of insulin, the clinical trials showed that “higher doses of Toujeo were required to achieve similar levels of glucose control compared in Lantus.” So, the conversion rate is backward.

Instead of taking a smaller dose than Lantus, you actually need an approximately 20% higher dose. However the dosing increments on the Toujeo pen have already been adjusted to account for this difference, so patients switching from Lantus to Toujeo should not have to engage in dose conversion calculations.

Several people have reported that Toujeo seems to work well for a few weeks and eliminates some of the issues Lantus has (such as frequent 3 a.m. hypoglycemic episodes and the burning pain of injecting the acidic Lantus).